Posts for Medicaid and Medicaid Expansion

Medicaid Expansion Improves Health and Access to Care, Survey of Montanans Finds

The hits keep on coming! A new survey of Montana Medicaid expansion enrollees confirms that Medicaid expansion dramatically improves access to health care, as well as overall health.

Fighting for Families: Five Health Care Policies State Legislators Should Push this Session

This week state legislators across the country are engaging in an annual week of action to lift up policies that promote economic opportunity and security for all families.

Screening for Social Needs: How Medicaid Can Address Social Determinants of Health

Several states are in the beginning stages of allowing their Medicaid program to deliver care to patients in ways that address their health-related social needs.

Deadline Approaching: Help Us Push Back Against Harmful Changes to Public Charge Rule!

Immigrant families remain the target of unjust policies that threaten their access to health care services and increase the fear of family separation. One of these latest attacks is the proposed changes to the public charge policy.

HHS Re-approves Kentucky HEALTH Waiver Despite Devastating Coverage Losses

Yesterday, the Department of Health and Human Services (HHS) re-approved the Kentucky HEALTH Medicaid Section 1115 application waiver, which imposes harmful changes to Medicaid such as a work requirements.

Behind the headlines: How support for Medicaid shaped the midterms

Utah, Nebraska and Idaho are the three most obvious illustrations of this phenomenon.

For People Living with HIV/AIDS, the Revised Public Charge Rule Could Mean Life or Death

Expansion of 'public charge' would incite a public health crisis and worsen the HIV/AIDS epidemic by undermining the ability of immigrants living with HIV/AIDS meet their health care needs.

The Takeaway: Who Are You Going To Believe, Me Or Your Own (Lying) Eyes?

In the past week we have seen Republican leaders such as the President and Senate Majority Leader along with many House and Senate candidates take to the media to try to persuade the public that they will protect people with pre-existing conditions.

Policy-Community Partnerships in Oral Health Advocacy: An Example in Celebration of National Hispanic Heritage Month

Latinx advocates have been leaders and partners in the strong health advocacy work across the country. In Virginia, advocates played a key role in the recent Medicaid expansion victory.

Integrating Care for Kids: A New Model and a Promising Opportunity

This is the first of two blogs on Integrated Care for Kids (InCK). Stay tuned for our upcoming blog on leveraging InCK for substance use prevention.

Back-to-School Checklist: Pencil, Notebooks, Backpack... Health Insurance?

Some children will show up nervous, some will show up excited and others will show up disappointed that summer is over. But, to us, the most important question is, will they show up insured?

The Verdict Is In: Arkansas Works Isn’t Working

A new report officially confirms all suspicions about whether Medicaid work requirements lead to coverage losses. Recently, the state of Arkansas, which began implementing its work requirement program, Arkansas Works, in June, reported that almost 7,500 individuals didn’t comply with...

Taking a Page from Maine’s Medicaid Playbook

The smart and consistent strategies employed by Maine advocates helped secure health care gains for thousands.

Virginia’s Vote to Expand Medicaid is Significant—Here’s Why

After six long years of legislative inaction on closing the Medicaid coverage gap, the Virginia legislature voted this week to expand Medicaid.

We Must Continue to Act to Address Gun Violence and Its Impact on Kids

Once again, our children have been confronted with another horrific, deadly school shooting.

Medicaid: A Lifeline to the Community

This blog is part of our Medicaid Awareness Month series, in which we highlight the ways that Medicaid supports the health of vulnerable populations. Guest bloggers for the series are state advocates who work on behalf of Medicaid from different...

Flood Them With Pink Slips

The Maine legislative session went late into the night last week as House members failed to reach consensus on funding their ballot-approved Medicaid expansion. Maine consumers passed a ballot question in 2017 demanding the state close the coverage gap for...

Meet Medicaid: The Unsung Hero of Long-Term Care

This blog is part of our Medicaid Awareness Month series, in which we highlight the ways that Medicaid supports the health of vulnerable populations. Guest bloggers for the series are state advocates who work on behalf of Medicaid from different...

Sharing Family Stories of Addiction to Promote Medicaid Expansion

This blog is part of our Medicaid Awareness Month series, in which we highlight the ways that Medicaid supports the health of vulnerable populations. Guest bloggers for the series are state advocates who work on behalf of Medicaid from different...

Medicaid Protects America's Children

This blog is part of our Medicaid Awareness Month series, in which we highlight the ways that Medicaid supports the health of vulnerable populations. Guest bloggers for the series are state advocates.

Think Medicaid Work Requirements Will Save Money? Think Again

In a previous blog, we wrote about how states hoping to impose work requirements on their Medicaid enrollees were touting projected cost savings - while failing to mention that these alleged cost savings result from people losing their health care...

Let’s Call the Alleged ‘Savings’ From Work Requirements What They Really Are: People Losing Access to Health Care

As more and more states begin to cite 'savings' as a reason to implement Medicaid work requirements, let's take a look at where that savings is coming from.

Happy 8th Birthday, ACA: Celebrating the ACA’s Important Role in Improving Health Equity

Eight years ago today, the Affordable Care Act (ACA) became law of the land, and this year’s birthday is truly one to celebrate.

Arkansas Becomes Third State to Impose Medicaid Work Requirements, and a Particularly Punitive Version

Yesterday, the Centers for Medicare & Medicaid Services (CMS) approved Arkansas’s Medicaid Section 1115 waiver amendment application.

Work Requirements for Medicaid Would Deepen Disparities in North Carolina’s Infant and Maternal Health

The Trump Administration’s recent guidelines endorsing work requirements for Medicaid beneficiaries could entrench existing barriers to successful pregnancies.

Medicaid Work Requirements Will Have Devastating Impacts for People with Complex Health Needs

For people with disabilities or complex medical conditions, accessing health care services is an absolutely necessary and often times incredibly stressful endeavor. Just getting the care needed to live a healthy and productive life can involve managing multiple appointments with...

And Then There Were Two: Healthy Indiana Plan 2.0 Becomes Second Medicaid Program To Add Work Requirement

Today, the Trump Administration and newly-confirmed Secretary of Health and Human Services (HHS) Alex Azar renewed the Healthy Indiana Plan (HIP) 2.0 Section 1115 waiver, including a work requirement on the Medicaid expansion population.

Medicaid Work Requirements: Bad Policy for All, Particularly Harmful to People With Addictions and People of Color

Time after time, the Trump administration talks about our country’s drug overdose crisis, yet its relentless attacks on health care simultaneously undermine access to life-saving treatment and services for people with substance use disorders. The most recent example: forcing Medicaid...

Voters Weigh in For Medicaid (Again)

In a special election two days ago, Oregonians voted overwhelmingly in support of their Medicaid program. Over 60 percent of voters cast their ballot in favor of keeping the provider taxes that cover the state’s share of Medicaid expansion costs....

Kentucky HEALTH: the “Kitchen Sink” of Bad Medicaid Waivers

On Friday, the Centers for Medicare & Medicaid Services (CMS) approved the Kentucky HEALTH Medicaid Section 1115 demonstration waiver, which contains very alarming barriers to coverage and care.

Picking Up Where We (and They) Left Off

Undeterred by either the stubborn refusal of facts to conform to their narrative or the unpopularity of their efforts to undermine the ACA and Medicaid, the Trump administration has picked up right where they left off.

By Opening the Door to Work Requirements in Medicaid, CMS Takes a Concerning New Direction of Prioritizing Penalties Over Coverage

The Centers for Medicare & Medicaid Services (CMS) announced in guidance today that they would allow work requirements in Medicaid through 1115 waivers, taking the program in an unprecedented and deeply troubling new direction.

The Hits Keep on Coming - Medicaid Expansion Helps Rural Hospitals Stay Open

This blog is part of a series highlighting recent research illustrating various benefits of expanding Medicaid - from improving health and state budget savings to reducing rates of uninsurance and uncompensated care costs.

Massachusetts: State Plan Amendment Paves the Way for Medicaid in Schools

Earlier this year, Centers on Medicare and Medicaid (CMS) gave Massachusetts the green light to amend their Medicaid state plan, opening the door for schools to bill Medicaid health services provided to all their Medicaid-enrolled students, not just those receiving...

The Hits Keep on Coming: Medicaid Expansion Shows a Myriad of Benefits

The list of benefits that expanding Medicaid provides to both individuals and states just keeps on growing. A comprehensive review of studies of the impacts of Medicaid expansion have found dramatic differences in Medicaid expansion versus non-expansion states along factors...

Policymakers Across the Country Take Note: Maine Voters Weigh in For Coverage, Against Obstruction

Yesterday, the people of Maine voted overwhelmingly to extend Medicaid coverage to 70,000 low-income Mainers. This finally ends the five-year-long battle to close the coverage gap in the state.  Maine’s legislature has passed Medicaid expansion with broad support five times...

CHIP: One Step Forward, Three Steps Back.

On Friday, CHIP refunding moved forward, ending Halloween week with a trick not a treat.

Fighting the Latest Threat to Addiction Services and Supports: The Graham-Cassidy Repeal Bill

Here we are again. Another disastrous health care repeal bill is gaining momentum, threatening the progress we’ve made in treating substance use disorders.

Veterans Protected Us, Now We Need to Protect Their Care

As veterans have fought so hard to defend us, we must fight to defend the health coverage they need and deserve.

Zombie Graham-Cassidy Bill Detracts from Bipartisan Efforts to Support Children’s Health

While Senators Hatch (R-UT) and Wyden (D-OR) are working on bipartisan solutions that support children’s access to health insurance, Senators Graham (R-SC) and Cassidy (R-LA) are throwing their energy into bringing Affordable Care Act (ACA) repeal back from the dead....

New Research Confirms Coverage For Parents Has Rolled Out “Welcome Mat” to Enrollment For Their Kids

New research confirms what we’ve known all along – the Affordable Care Act (ACA) improves the lives of families. According to a recent Health Affairs analysis, over 700,000 children who were eligible for Medicaid or Children’s Health Insurance Program (CHIP)...

Handle with Care: Back to School Amidst Charlottesville

For many families across the country, August is the month of “back to school.” For us in the health advocacy world, it is commonly the month that we focus on health care program enrollment.

Senate Repeal Bill 2.0: The Same Old Problems with a New Bad Idea

Yesterday, after three more weeks of backroom deals and secret negotiations, Senate Majority Leader Mitch McConnell unveiled a ‘new’ health care repeal bill that features all the same failings of the previous version.

The BCRA’s Capped Medicaid Funding Would Heighten States’ Budgeting Woes for Decades

CBO found that the proposed legislation would cut $772 billion from Medicaid – slashing its funding by 26 percent in 2026, compared to current projected funding.

Structural Racism and Maternal and Child Health

Now is the time when we have to eliminate the racist narrative of the “welfare queen.”

Senate Repeal Bill Leaves Medicaid Expansion Enrollees Behind

The Senate yesterday delayed its plan to vote on its health care repeal bill, also known as the Better Care Reconciliation Act of 2017 (BCRA). On Monday, the Congressional Budget Office (CBO) released its score of the bill and projected...

You Ain’t Seen Nothing Yet: What’s Lurking Beyond the Horizon of the CBO Score

By now, you’ve already seen the key takeaways from the Congressional Budget Office (CBO) score of the Senate repeal bill. But what you might not know is that the CBO score hides the most devastating of the Senate bill’s effects.

The Takeaway: What's the Deal in the Senate?

Don't expect to see the bill in advance.

The Takeaway: Masters of Misdirection

In the wake of both developments last week, we were treated to so many breathtaking whoppers that it is hard to know where to begin. If there were an award for double-speak, there would be a rich candidate pool from which to draw.

Rolling Back Progress: Medicaid Cuts Would Deny Children of Color Access to Care

The AHCA, as passed by the House of Representatives and sent on to the Senate, would reverse the progress on children’s coverage that has been made through the ACA.

Trump Budget Attacks Low-Income Communities, State Budgets, Children

Despite his repeated promises on the campaign trail that he would not cut Medicaid, President Trump’s FY 2018 budget would slash the program’s budget nearly in half over the next decade. The budget assumes the $839 billion in Medicaid cuts...

“We Don’t Just Take It, We Take Charge!”– Celebrating Older Americans Month

It’s May, and that means it’s Older Americans Month. This year’s theme is Age Out Loud, chosen “…to give aging a new voice – one that reflects what today’s older adults have to say.” Older Americans are a group that...

The Takeaway: Why Trumpcare Collapsed and What Comes Next

After reflecting on last week’s collapse of the drive to repeal the Affordable Care Act, we can reach some good conclusions about what went down and draw some lessons for the future.

The Takeaway: An Act of Malice

  I would venture to guess that congressmen Paul Ryan and Joe Kennedy don't agree on too much, but one thing they do appear to agree on is that the ineptly named American Health Care Act (aka Trumpcare) is first...

The Takeaway: Why is the GOP health care plan so terrible?

Reviews are in on the House GOP health care plan, which has been enthusiastically embraced by President Trump, and they are pretty terrible.

Top 5 Reasons the House GOP Bill to Repeal the ACA is Bad for Children and Families

The GOP Health Care Repeal Bill will negatively impact millions, but low-income kids, working families and communities of color will be hit particularly hard.

The Takeaway: A Secret They Should Have Kept: House GOP Plan Would Benefit the Wealthy, Harm Most Others

Although it will undoubtedly undergo further revisions, we now have a pretty clear idea of what the House Republican health plan entails - and it's not good.

The Takeaway: Math Problems

As Republicans struggle to come to agreement on how far to go with ACA repeal and what to put in its place, they are confronted with three interlocking math problems.

Just Another Messaging Document Masquerading as an ACA Replacement Plan

Yesterday, House Republican leadership released another "replacement plan," the Obamacare Repeal and Replace Policy Brief and Resources. After nearly seven years, Republicans continue to call for replacement of the Affordable Care Act but have yet to put forward a plan...

Why We Love CHIP – Because It’s Much More Than Coverage

One of the most shameful failures of our public safety net system is when structural harm goes unaddressed. The lead crisis in Flint, Michigan remains a painful reminder of when blind commitment to cost savings results in irreversible harm for...

The Takeaway: Same Old Snake Oil In A New Bottle

While the change is a welcome testament to the success of the resistance to date, it does not reflect any change in purpose on the part of most Republicans in Congress.

Recent Victories and Forward Momentum: February is a Key Time for Action

In the wake of Republican efforts to unwind the Affordable Care Act while failing to coalesce around a replacement plan, consumers are increasingly concerned that they will lose the coverage and protections they have gained since passage of the ACA....

The Replacement Charade Begins: Collins, Cassidy and Paul release “plans” to repeal and replace ACA

Republicans recently introduced two bills to “replace” the Affordable Care Act – one co-authored by Senators Susan Collins (R-ME) and Bill Cassidy (R-LA) and another by Senator Rand Paul (R-KY). Neither bill has been endorsed by Republican congressional leadership and...

States Face Immense Budget Impacts If the Affordable Care Act Is Repealed

Thanks to the Affordable Care Act (ACA), the uninsured rate in the United States declined to 8.6 percent in the first quarter of 2016, the lowest level on record.

Beware of Block Grants: Along With ACA Defense, We Need to Protect Medicaid Too

Kellyanne Conway signaled the new administration’s desire to convert funding for the Medicaid program to block grants to states, with the assertion that doing so would mean "those closest to the people in need will be administering the program."

Double Jeopardy for Children with Disabilities

As we face a future that could hold the repeal of the ACA and the emergence of a Department of Education that does not stand up for the civil rights of children with disabilities, I am acutely aware of the lose-lose situation for kids and their families.

Medicaid Innovation Would Flatline Under Block Grants and Per Capita Caps

[Medicaid] has meant many more kids, grandparents and people with chronic health conditions have been able to get the care they need

Uncertainty Around ACA Stirs Fear In Immigrant Communities

Following the election of Donald Trump, immigrant communities have grown increasingly anxious about their safety and well-being.

The Takeaway: Pay No Attention to the Plan Behind the Curtain

It's funny, or at least it would be if it weren't so sad and so dangerous. Lack of transparency in health care is a problem that has often been decried. You buy health insurance, but you don't really know which providers are in-network.

The Takeaway: Will the Real Donald Trump Please Stand Up?

It is often said that the first casualty of war is the truth. In the coming war on health security for the American people, one question is whether Donald Trump was sincere when he said he would not cut Medicare...

The Takeaway: How Do the Political Scientists Explain This One?

One curious feature of our current moment in health policy is how divergent the impending course of action pledged by Republicans in Congress and the incoming Trump administration is from the preferences of major health care industry stakeholders. Dominant models...

The Takeaway: Health Care and the Election - The Fight For Health Care Justice Must Continue

How the voters thought about health care The election is over and Donald Trump, to the surprise of most people (including, apparently, the Trump campaign team) will be the next president of the United States. Although this will have profound...

For More than 73 Million People, It Is Critical that We Protect Medicaid and CHIP

73 million. 73 million. This is the number of people who rely on Medicaid for their health coverage - and almost half of them are children. It’s the number that stands out on the screen as we read Kaiser Health...

Serving Those Who’ve Served: Close the Coverage Gap for Uninsured Veterans

On November 11, many of us will gather to mark Veterans Day and to honor the courageous individuals who have served our country.

New England Leads Trends For Growth In Children’s Health Coverage

Coverage success for children did not happen overnight and is not static. As we enter the next open enrollment period, we are reminded that coverage and maintaining coverage is ongoing and requires year-round support.

States’ Role in Preventing Churn: The Good and the Bad

Thanks to the Affordable Care Act (ACA), 20 million people have gained health insurance coverage, creating a pathway to better health. However, holding on to that coverage is not always easy and barriers remain for many consumers. Even with the...

CMS Provides Arizona Families with a ‘Waiver’ of Relief

On Friday, the Centers for Medicare and Medicaid Services (CMS) announced some good news for Arizona’s children and families.

Advocates and CMS Agree, Ohio’s Medicaid Waiver is Not Healthy for Ohio

Last week, the Centers for Medicaid and Medicare Services (CMS) rejected Ohio’s “Healthy Ohio” Medicaid waiver proposal, which included provisions that would have undermined health coverage for many low-income Ohioans. Among other changes, the state requested permission to require low-income...

Non-Emergency Medical Transportation: Pathway to Better Health Outcomes

Even with health care coverage, Medicaid beneficiaries still find themselves facing numerous barriers to accessing the care they need and achieving better health outcomes. One barrier that continues to cause serious access problems is transportation.

Louisiana Is a Health Care Innovator (Yes, Louisiana!)

Louisiana is the leading the way when it comes to being innovative to improve the lives of its citizens. Our new Governor John Bel Edwards boldly campaigned that he would expand Medicaid in a deeply red state.

What’s the Buzz on Closing the Coverage Gap to Fight Zika?

This month, the first wave of locally-transmitted Zika virus infections in the continental United States in Florida could signal the escalation of a public health crisis with lasting consequences.

Connecticut’s Summer Slog

Transitioning between Medicaid and Marketplace coverage can create health care potholes for consumers, placing them in harm’s way. Transitioning coverage can be further complicated by challenges with health literacy and health insurance literacy

A Deeper Look at the Critical Role of Community Health Centers in Advocacy

Community health centers have traditionally been the primary source of care for underserved populations with the greatest health needs.

Engaged Consumers: The Key to Better Value in the Empire State

Last week, I had the privilege of attending the United Hospital Fund’s 2016 Medicaid Conference in New York City. This year’s conference focused on ongoing efforts in New York’s Medicaid program to develop delivery and payment systems that reward value...

Momentum Is On Our Side: Vermont Votes Yes on Dental Therapists

On Monday, Vermont Governor Peter Shumlin signed a new law that will allow dental therapists to work in Vermont. It’s an exciting victory on a number of levels. To start, this makes Vermont the fourth state to add dental therapists...

Florida Needs More Than Flowers

Last June, following the mass murder in Charleston, South Carolina, Anton Gunn, a South Carolinian and Community Catalyst board member, commented on Governor Nikki Haley’s (R-SC) change of heart about taking down the Confederate flag from the grounds of the South...

A Nurse in EVERY School

While school nurses have long been recognized for their vital role in supporting children’s educational success through better health, there is increasing recognition that school nurses are integral to reforming our health care delivery system. School nurses are the eyes...

A Super-Condensed Advocate’s Guide to the New Medicaid Managed Care Rules!

Medicaid managed care just got a dramatic update that will align it more closely to the Affordable Care Act (ACA) Marketplaces and Medicare Advantage over the next several years. In Medicaid managed care, the state pays managed care plans to...

How Arizona Got KidsCare Back: The System of Advocacy at its Best

After six years without it, about 30,000 children in Arizona will once again have access to affordable, high quality health care coverage. Late last week, in an exciting turn of events, Arizona’s Legislature pushed through a measure to reinstate KidsCare,...

Full Steam Ahead! Advocates Shaping the Conversation on Closing the Gap in Idaho

After years of silence within the Idaho Legislature on closing the coverage gap, and no visible intention of addressing it in the 2016 legislative session, advocates refused to leave 78,000 Idahoans in the gap and successfully shifted the conversation on...

The Takeaway: Closing the Coverage Gap—It’s Getting Better All the Time

There’s not much the Obama administration can do to persuade states to take up the already generous terms available for closing the Medicaid coverage gap, especially in an election year. But they are doing what they can to sweeten the...

Closing the Coverage Gap Helps Knock Down Stubborn Health Disparities

The fourth in our National Minority Health Month blog series. For National Minority Health month, we are celebrating the 32 states including the District of Columbia that have chosen to close the coverage gap. Not only have these states extended...

Best Practices in Ensuring Health Coverage for All Children

Earlier this month, Florida joined 29 other states that offer Medicaid and CHIP coverage to children and pregnant women who legally reside in this country under five years. We, in Ohio, celebrate this monumental step with our friends in Florida....

New Tool to Improve Behavioral Health in Medicaid and CHIP

Finally we have the tools we need to ensure Medicaid appropriately serves behavioral health consumers.

The Takeaway: Cruz Issues An ACA Replacement Plan (April Fool)

Actually, he has done no such thing. His willingness to bring the federal government to a grinding halt in order to grandstand on the issue earned him a lot of notoriety. But when it comes to “replace,” the candidate remains vague at best.

Behavioral/Physical Health Integration: Twin Cities Flashback

This week’s release by the Medicaid and CHIP Payment and Access Commission (MACPAC) of its Report to Congress highlighted the critical importance of Medicaid in the lives of so many low-income Americans. While the report focuses on Medicaid payments to...

The Takeaway: Final Obama Era Insurance Rule Makes Incremental Progress But Leaves Many Issues Unresolved

Every year, the Department of Health and Human Services (HHS) issues an update to the rules governing insurance companies and marketplaces. While there were many small adjustments the final update released Monday, the last under President Obama, can most fairly...

Report: Proof that a Strong State Advocacy Infrastructure Influences Coverage Gap Decisions

A recent article published by the American Journal of Public Health (AJPH) affirms what is at the core of Community Catalyst’s mission: a strong, organized consumer health advocacy movement is critical to moving states to extend health coverage to low-income...

Medicaid is Growing Up. It’s Time to Go to School.

Thanks to a clarification by CMS regarding the “free care” rule a little over a year ago, schools can be reimbursed for services provided to Medicaid-eligible students. This was a subject of a conference call and toolkit released earlier this...

The Takeaway - Flint: How Did This Happen And What Does It Mean?

Flint: How Did This Happen And What Does It Mean? In my opinion, the biggest health care story of the week is the continued fallout from the lead contamination of the water supply in Flint, Michigan. The Flint crisis underscores...

The List of Benefits of Closing the Gap for Families and States Keeps Growing

Here’s another one to add to the growing list of benefits of closing the coverage gap. A recent study in Health Affairs confirms that closing the coverage gap improves access to and affordability of care for low-income adults. Compared to...

New Report Highlights Progress, Room for Improvement in Health Coverage Gains for Hispanic Children

Last Friday, the Georgetown Center for Children and the National Council of La Raza co-released a report detailing recent gains in health coverage for Hispanic children. Among the key findings in the report is that the uninsured rate among Hispanic children dropped...

Arizona Kids are Falling Through the Cracks Without Active KidsCare Program

by Joe Fu, Children’s Action Alliance For the fifth year in a row, Arizona had the third highest child uninsured rate in the nation. In 2014, 10% of Arizona’s children were uninsured compared to about 6% nationally, according to a new...

Closing the Coverage Gap: How a Sweet Deal Might Get Even Sweeter

Talk about sweetening the pot. Today, the White House announced that President Obama’s Proposed 2017 Budget will create a new incentive for the remaining 19 states to close the coverage gap and insure millions of Americans. President Obama’s proposal would...

The Takeaway 2016 New Year’s Edition

Why Is This News? 2016 opened with yet another vote by the Republican controlled Congress to repeal the ACA coupled with more muttering about a replace agenda — we really really mean it this time. Maybe by the time we are...

The Takeaway: Gun Violence is a Public Health Issue. Time for Congress to Treat it Like One

Gun violence in the US seems to have reached epidemic proportions averaging at least one mass shooting per day in 2015. According to OECD data 87 percent of the children in the developed world who die from gun violence live in the...

Children in Foster Care Need More Holistic Health Care

Over the last few years, states have witnessed widespread failings within agencies charged with overseeing the well-being of children in foster care.

Dear South, There's Hope!

In the last two weeks, some major developments have rekindled hope for hundreds of thousands of Southerners left in the coverage gap. Since a disproportionate number of people in the coverage gap, 90 percent, live and work in the South,...

Marketplace-CHIP Comparability Study Is Out: Where Do We Go from Here?

Just before the Thanksgiving holiday, Health and Human Services (HHS) released the long awaited Certification of Comparability of Pediatric Coverage Offered by Qualified Health Plans.

The Takeaway: Reason Slowly Gaining Ground Over Ideology in Medicaid Debate

Reason Slowly Gaining Ground Over Ideology in Medicaid Debate When the Supreme Court ruled that states were not required to expand Medicaid to cover all poor adults, as originally envisioned by the ACA, it touched off a fierce political struggle...

The Takeaway: More Signs of ACA Success but There's Still Work Left to Do

Michael Miller talks insurance merger mania, tackling out-of-pocket costs and more data touting the success of the ACA in this week’s edition of The Takeaway.

Medicaid Managed Care is Getting a Makeover

Community Catalyst recently submitted comments to the Centers for Medicare and Medicaid Services around proposed regulations that make sweeping updates to Medicaid Managed Care.

The Takeaway: The South Leads the Nation…A Phrase We Don’t Often Get to Say

This week, Gallup released the results of a two-year survey on the nation's uninsured and the results have stunning implications for the South.

We can reduce health disparities and ensure that ALL children have health coverage

Ensuring that families of all ethnic backgrounds access the health care they need to be healthy is one of the most important things we can do for our nation’s children.

Washington Uninsured Rates Among Lowest in the Nation with New Medicaid Options

Before new coverage options under the Affordable Care Act (ACA) rolled out in October of 2013, Washington CAN! mobilized to make sure the state accepted federal funds to cover low-income adults through Medicaid.

The Takeaway: Medicare and Medicaid at 50

Michael Miller reflects on the 50th Medicaid and Medicare Anniversary

North Carolina’s Direct Care Workers in the Coverage Gap

A recent paper from the Paraprofessional Healthcare Institute indicates that of North Carolinians who are affected by the Medicaid coverage gap nearly 10 percent are direct-care workers.

Celebrating the Golden Anniversary of Medicare and Medicaid – Looking Ahead to the Next 50 Years

Fifty years ago today, President Lyndon B. Johnson signed into law the landmark amendments to the Social Security Act that created the Medicare and Medicaid programs.

Closing the Gap in Indian Country

Right now, Hannah is uninsured. She can’t afford health insurance and doesn’t make enough to qualify for tax credits.

Medicaid: A Win for Families and our Future

At Voices for Virginia’s Children, we are reflecting on Medicaid’s 50th anniversary and what the program has meant to generations of children and families here in Virginia.

The Takeaway: Michael Miller's Congressional Forecast, The Weather Looks Stormy

Michael Miller's The Takeaway, featured in On Message on July 24, 2015.

Investing in Medicaid is Paying Off for Colorado

On Medicaid’s 50th anniversary, it’s worth a look back at how the biggest expansion in the program’s history has helped Coloradans.

Medicaid reform – A Tale of Two States

Medicaid provides health and financial security for millions of low-income, working Americans. Despite the fact that Medicaid is as efficient as (or even more efficient than) private insurance, it is often a target of state budget cuts.

Closing the Gap Is About More Than Just the Bottom Line, But It Helps

Failing to close the gap is a missed opportunity for consumers, hospitals and states. The uninsured rate in the 30 states (including D.C.) that have closed the gap fell from 18 percent to just below 11 percent.

Yes, Remove the Flag. And Close the Coverage Gap to Really Address Racial Inequality

South Carolina Governor Nikki Haley has called for the removal of the Confederate flag from the State House. Yet, she remains adamantly opposed to accepting the federal dollars set aside to extend Medicaid coverage to low-income South Carolinians.

Going the Extra Mile for Rural Hospitals

This month, a small town mayor, Adam O’Neal, and civil rights activist, Bob Zellner, are leading a 283 mile walk from Belhaven, NC to Washington, DC to call on lawmakers to close the coverage gap and help ensure that rural hospitals can remain open.

Building Bridges to Better Health

To mark Older Americans Month, the Voices for Better Health project has debuted a new video highlighting an important strategy to improve the health and well-being of vulnerable older adults.

Insurance coverage for parents and kids creates long-term success and health

The Institute for Research on Poverty released a new study that provides further confirmation that Medicaid and CHIP contribute to the long-term health and success of children

People Prevail Over Politics in Montana

This week, Montana becomes the 29th state (plus the District of Columbia) to close the coverage gap, and the first state to get legislative approval to expand Medicaid in over a year.

CHIP Success: Where Do We Go From Here?

Yesterday, we alerted our partners to the great news that the Senate had passed H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

The Benefits of Closing the Gap on State Budgets Keep Adding Up

We know we’re starting to sound like a broken record, but we couldn’t help but share that yet another report boasts how closing the gap is good for state budgets.

An Open Letter: Dear Governor, Protect Coverage

As you continue budget conversations with your state legislature, state consumer health advocates urge you to protect health insurance coverage programs that help consumers achieve financial stability and good health.

Happy Fifth Birthday, ACA!

The passage of the ACA was a monumental achievement for individuals and organizations across the country. We continue to be incredibly proud of all our state partners who have worked tirelessly to implement the law.

Slow but Steady: Red States Make Progress Closing the Coverage Gap

A few recent headlines suggest that red states stopped making progress on closing the coverage gap, but these headlines don’t accurately describe the coverage gap debate.

States Report that Closing the Coverage Gap is Good for Budgets

The evidence confirming that closing the coverage gap is good for working families and state budgets continues to pile up.

Closing the Gap in Kentucky Brings Better Coverage, New Jobs, State Savings, and a Boost to Providers

Good news from Kentucky provides compelling evidence that closing the gap is the right decision, and we hope other states take note.

Moving CHIP Forward: Discussion Draft Demands Response

Yesterday, Senate Finance Committee Chairman Hatch (R-UT), House E&C Chairman Upton (R-MI), and Representative Pitts (R-PA) released a discussion draft that outlines their vision for the future of CHIP.

Cross-Post: Will dental therapists “change the world” (of U.S. dental care) in 2015?

Change is hard. Change takes time. Change is worth fighting for especially when it relates to improving access to oral health care.

The Smart Shopper's Guide to Medicaid Managed Care Plans

In this season of giving, Community Catalyst has teamed up with the Kaiser Family Foundation to create an online tool that gathers in one place, for the first time, key data on the records of these companies.

Transforming Our Health System: Bringing Drug and Alcohol Treatment into the Fold

With more people gaining access to care, this is a crucial time to strengthen the way we provide and pay for health care. Integrating services for drug and alcohol problems with other care can play a big role in transforming the health system.

50 State Report: Let’s keep fighting for children’s coverage

Following years of decline, uninsurance rate for children are holding steady, according to a report that Georgetown Center for Children and Families released today. Their annual 50-state report provides a detailed picture of kids’ coverage at the state and national...

Closing the Coverage Gap Won’t Accelerate State Medicaid Spending

We covered more people, and spending went up as a result – this isn’t a particularly interesting story. But the data actually tells a far more intriguing story, buried just a little deeper in the report.

Celebrating Milestones and Acknowledging Challenges Ahead for Latino Health Coverage

Since today is the last day of National Hispanic Heritage Month, we are celebrating the gains in health care coverage for Latinos since the Affordable Care Act (ACA) went into effect.

What does the Coverage Gap have to do with kids? A whole lot, it turns out.

Last week, Virginia’s General Assembly once again took up the issue of closing the coverage gap, and once again struck the measure down. The primary goal of last week’s special session was to discuss the closure of this gap: Governor...

Making Outreach and Enrollment Work for Former Foster Youth

As we gear up for the next open enrollment period, it’s worth revisiting the ACA’s provision for former foster youth. Thanks to the ACA, youth who age out of foster care are eligible for Medicaid up to age 26.

Medicaid and CHIP: Proven Tools to Reduce Health Disparities

Today is CHIP’s 17th birthday! As we reflect on the success of this important program, a recent report nicely summarizes its impact.

Recognizing National Foster Care Month

May is National Foster Care Month, and it is a great time to reflect on the unique health needs of youth who are or have been in foster care and how the Affordable Care Act (ACA) helps to support these...

Health Equity in Focus: Taking a Closer Look—Successful enrollment strategies in New Jersey

In New Jersey, the final enrollment numbers attest to the coordinated efforts enrollment specialists and consumer health advocates activated across the Garden State. With more than 162,000 New Jerseyans enrolled in the Marketplace in this first open enrollment period, and...

Update: Medicaid Expansion Becomes a Reality in New Hampshire

At the beginning of March, we were thrilled to report that the bi-partisan way had been paved for New Hampshire to expand its Medicaid program. With Senate approval of Senate Bill 413 in hand, the House passed the Medicaid expansion...

New Tools to Cut Medicaid Churning

One of the goals of the Affordable Care Act (ACA) is to increase the number of people who have access to health insurance, no matter what their life or economic circumstances. We are all working hard to ensure the ACA...

A Day in the Life: One Navigator’s Experience in Bedford County, PA

Navigators, assisters, and certified application counselors are the unbiased people who are there helping consumers understand what the Affordable Care Act means for them and the new insurance options available to them through the law. We want to elevate their...

Bipartisan (yes, that's right) passage of Medicaid Expansion in New Hampshire

New Hampshire consumer advocates and supporters of Medicaid Expansion are waking up today to a new chapter in coverage for New Hampshire residents. With bipartisan support, Senate Bill 413 passed yesterday 18-5 in the Republican-controlled Senate. It is expected to...

And This Shout Out Goes to....FLORIDA CHAIN!!

And This Shout Out Goes to...Florida CHAIN!!! Amidst a challenging political environment for Medicaid expansion efforts, Florida CHAIN Organizer Ryan Morris found a way to show how much of a “joke” rejecting Medicaid expansion is for the sick and working...

Going for the Gold by Helping Consumers Get Good Care

If sports offer lessons for life, we might look to Sochi for a few pointers. For starters, the Sochi Olympic Winter Games attracted more participants than ever. But as those of us glued to our televisions have seen, the path...

Happy Anniversary, CHIPRA! Why it matters, and what’s next

Today marks the fifth anniversary of the Children's Health Insurance Program Reauthorization Act (CHIPRA), which extended the authorization for CHIP. In honor of this anniversary, we want to reflect on all the great gains in children’s health coverage we've made...

Pharma’s End Run on Medicaid Spending Controls Hits Consumer and Congressional Opposition

Earlier this month, Community Catalyst joined other national organizations calling on the Obama administration to change the direction of economic treaty negotiations that could impact cost containment by federal and state health programs.

Takeaways from NEACH’s 2013 Children’s Health Summit

Earlier this month, the New England Alliance for Children’s Health team gathered with our partners from around New England to discuss current events and future issues in children’s health policy. We were pleased that partners from all six New England...

States to Decide Medicaid Eligibility for Same-Sex Couples

The Supreme Court’s decision on the Defense of Marriage Act (DOMA) was met with much elation by advocates pursuing marriage equality. The federal government has been working, since that momentous decision was released, to clarify just how it impacts various...

50-state Report: Kids Coverage Improving Thanks to Medicaid and CHIP

Our friends at Georgetown Center for Children and Families today released their 50-state report on children’s health coverage, which provides a detailed picture of the coverage landscape for kids. Overall, the news is positive: 92.8 percent of kids have insurance...

Focus on Few, Increase Savings for Many: The “Genius” of Targeting “Super-utilizers”

“[The patient] had severe congestive heart failure, chronic asthma, uncontrolled diabetes, hypothyroidism, gout, and a history of smoking and alcohol abuse. He weighed five hundred and sixty pounds. In the previous three years, he had spent as much time in...

Behind Every Great Medicaid Champion is an Even Greater Advocacy Community

Ohio recently became the 25th state (plus DC) to expand Medicaid under the Affordable Care Act.

Connecting the Dots between Hospital Financial Assistance and the ACA

It is time to connect hospital financial assistance to the rest of the ACA. It could make a difference for millions of people.

Enrolling Thousands of Medicaid Beneficiaries is a Snap (Pun Intended!)

A handful of states are quickly enrolling certain Supplemental Nutrition Assistance Program (SNAP) participants into Medicaid.

I Still Haven’t Found What I’m Looking For: Improving Behavioral Health in Medicare and Medicaid

Senators Max Baucus and Orrin Hatch recently asked the behavioral health community to help answer questions about barriers to behavioral health care and effective integrated care models.

Health Equity in Focus: Equality in Coverage: Getting 293,932 LGBT Georgians Health Care

To celebrate National Coming Out Day we wanted to showcase the partnership Georgians for a Healthy Future and Georgia Equality have formed over the past year to advance access to health care for the state’s nearly 300,000 LGBT citizens.

Dig Into Our New Managed Care Checklist

We recently unveiled a checklist for making managed care consumer-focused.

There’s A Hole in Our Bucket: Addressing Children’s Health Insurance Churn

Pursuing health coverage for all children can sometimes feel like pouring water into a leaky bucket. Even when outreach and enrollment efforts are strong, a substantial portion of children will lose their insurance at least once.

Some Kids Will Still Face Waiting Periods for CHIP, Unless States Act

Nothing says “long weekend” like a long list of regulations, right? While most of us were still recovering from our Independence Day celebrations, the Centers for Medicaid and Medicare Services (CMS) released a 600-page final rule.

Making Medicaid Enrollment Easier -- for People and for States

Advocates, stakeholders, federal and state governments are busy planning strategies for enrolling millions of newly eligible people into health coverage in 2014. But last week, CMS quietly released guidance that could lighten the load on everyone.

Help for Improving Long-Term Services

After a long gestation, the federal government this week birthed new guidance designed to help managed care for Medicaid long-term services and supports (MLTSS) grow up into a more consumer-friendly, homey program.

Engaging Veterans in the Medicaid Expansion

At Community Catalyst, we believe everyone should have a say in the decisions that affect their health. Many governors are now making decisions that affect the health of thousands of veterans and their families.

New Polling Shows Strong Support for Expanding Medicaid in the Deep South

This week advocates in the South received yet another good reason to push for expanding Medicaid in their states.

New Study Builds Case for Expanding Medicaid

A new study in the New England Journal of Medicine confirms what consumer health advocates have known for decades: Medicaid is essential for keeping low-income households on stable financial footing.

The Morning After

OK. Sequestration has happened. That means funding cuts for community health centers, public health and medical research. Medicare provider payments will be shaved by two percent while Medicaid and CHIP are exempt.

Improving Medicaid: Federal help to expand home care

Is your state still stowing in nursing homes people who could live at home with adequate help ? Is the state spending millions of Medicaid dollars on institutional long-term care when they could get federal funds to expand the less expensive community ser

The Insider: Health care and the fiscal debate: Where are we now and where are we going?

As the final days of 2012 slip away, little time remains for Congress and the President to strike a deal on tax rates and spending levels. If there is no deal, a host of tax cuts enacted under both Presidents Bush and Obama will expire (along with a numbe

Highlights from 2012 NEACH Children’s Health Care Summit

On November 14, Community Catalyst’s New England Alliance for Children’s Health (NEACH) hosted its annual Children’s Health Care Summit in Worcester, Massachusetts. The summit covered topics such as consumer assistance programs, foster youth and the Affor

Washington State First to Receive Approval to Implement a Managed Fee-for-Service Duals Demonstration Program

Last month, Washington became the second state to sign a Memorandum of Understanding (MOU) with the Centers for Medicare and Medicaid (CMS) to participate in a duals demonstration project. Washington is pursuing a managed-fee-for-service financial model u

Navigating Managed Care’s Strange New World

State Medicaid programs have been moving at warp speed to turn over long-term services and supports (LTSS) to managed care companies. For some states, this marks the first journey into the tricky terrain of mandatory managed care for seniors and people wi

Medicaid’s Got Friends in High Places

Recently, a stakeholder group in Iowa put out a bold statement urging state legislators not to reject the Medicaid expansion: “Failure to seize this historic opportunity to significantly address the plight of uninsured Iowans has negative consequences for

Ensuring Better Care and Health Outcomes for Individuals with Sickle Cell Disease

The Sickle Cell Treatment Act (SCTA) provides an important opportunity to advocate for implementing public policies that will lead to better care and health outcomes for individuals living with sickle cell disease (SCD). In 2003, Senators Jim Talent (R-MO

Something to Celebrate: Three Big Birthdays, One Short Week

Three programs vital to the health care security to millions of Americans celebrated birthdays last week. Medicaid and Medicare turned 47, and their “little sibling,” the Children’s Health Insurance Plan (CHIP), also marked 15 years of ensuring low-income

Basic Health Program: This Wallflower is About to Bloom

The Basic Health Program isn’t the most flashy or popular provision in the Affordable Care Act. But anyone who’s watched a classic – or even a less-than-classic - teen romantic comedy knows that the shy, somewhat awkward wallflowers often have tremendous

Medicaid Makes States an Offer That Is Too Good To Refuse

Today, the Supreme Court will hear arguments on whether the Affordable Care Act (ACA)’s Medicaid expansion (the planned increase in the number of low-income adults who are able to receive Medicaid coverage in 2014) is constitutional. The plaintiffs will a

Hand Over the Megaphone: New CMS Regulations Strengthen the Consumer Voice

In the obscure pages of the Federal Register, consumers recently won an important victory -- a victory whose implications for Medicaid beneficiaries are anything but obscure. Last week, the Centers for Medicare & Medicaid Services (CMS) released a fin

Confronting Our Dirty Little Secret

After a decade of reports and tragedy a lot of progress must be made to improve our oral health A decade ago, the Surgeon General released a report on oral health that described unmet oral health needs as a “silent epidemic”. Five years ago, a 12 year old

Guest Blog: Home Care Workers Need Your Support

On December 15, 2011, President Obama announced that the Department of Labor planned to amend the Fair Labor Standards Act (FLSA) to guarantee minimum wage and overtime protections for 2.5 million home care workers. Since 1974, when Congress amended the F

The New Boom in Managed Care: Long-term Services and Supports

A new report from AARP captures the changes coming for people who depend on Medicaid for services that help them live with chronic illnesses and disabilities. The number of states that actively manage long-term services and supports in Medicaid will nearl

A Principled Approach to Better Care for Seniors and People with Disabilities

Efforts to improve care for seniors and people with disabilities across the country are speeding forward as states take advantage of funding and flexibility offered by the federal government. These initiatives to serve people eligible for both Medicaid an

States of Innovation 3

Paying Pharmacies Honest Prices for Prescription Drugs As policymakers across the country look to balance their budgets, some are turning to Medicaid, recycling the same harmful policies they’ve used year-after-year: eliminating coverage for vulnerable A

Oh so close…

While the New England states are leaders in the nation in reducing the number of uninsured children, with coverage rates from 94 to 98 percent across the region, there is one area where New England is falling woefully behind. According to a new report fro

The Unhealthy Consequences of Congressional Dysfunction

After caving in to a rebellion from the tea-party wing of the House Republican caucus, Speaker Boehner has pulled the plug on a bipartisan agreement to do a two month extension on a number of expiring federal policies -- including a patch on the Medicare

Medicaid and the Children’s Health Insurance Program Buffer the Impact of the Recession on Children

In most respects, children have not been exempt from the impacts of the current economic downturn. The number of children living in poverty in the United States rose to 15.7 million in 2010—a 19 percent increase from 2008. Despite this bleak picture, a ne

Super Committee Failure: It Could Have Been Worse!

Late Monday, the 12 members of the Joint Select Committee on Deficit Reduction (aka the “Super Committee”) announced their failure to agree to a debt-reduction package. How should consumer health advocates react to the news? A Plague on Only One of Your

First Quarter: Supreme Court Ready to Tackle the ACA

The awaited day is here. The Supreme Court announced that it will hear the case against the Affordable Care Act’s (ACA) individual responsibility requirement (and other related requests). For those immersed in football season, this is the Super Bowl of le

Basic Health Program: Putting the “Affordable” in the Affordable Care Act

Last week, Community Catalyst submitted comments to HHS about the Basic Health Program (BHP) option in the Affordable Care Act (ACA.) While there are many reasons to be enthusiastic about BHP, its potential to dramatically lower health care costs for some

Medicaid and State Budgets: Same As It Ever Was?

Kaiser Family Foundation released a report last week, detailing results from a 50-state survey of Medicaid budgets. Kaiser’s results tell a classic story known as The Life and Times of a Countercyclical Program. Those of us who work in Medicaid policy hav

The Insider: News Round Up

File Under: “…and don’t let the door hit you on the way out” Recently, two Florida insurers announced their intention to quit the non-group health insurance market in that state. The state of Florida is trying to use the exit to bolster its case for a wai

We Can Have Our Deficit Reduction and Keep Our Health Security Too

Yesterday, President Obama released a plan to reduce the deficit by more than $3 trillion over the next decade. It’s certainly not perfect, but his plan achieves these savings while largely protecting health security for the low-income families that rely

States of Innovation 2

A Team Approach to Care As policymakers across the country look to balance their budgets, some are turning to Medicaid, recycling the same harmful policies they’ve used year-after-year: eliminating coverage for vulnerable Americans, restricting critical

How the Affordable Care Act Helps Youth Aging Out of Foster Care

Mandatory Medicaid coverage for former foster care youth who have aged out of the foster care system but are in care as of their eighteenth birthday—an important provision in the Affordable Care Act (ACA) that isn’t as widely known as it should be—is fina

Debt-Ceiling Compromise Kicks Medicaid Fight Down The Road

Yesterday, the president signed a bill that ended months of intense negotiations over lifting the country’s debt-ceiling. But for the fate of Medicaid – and the millions of seniors, people living with disabilities, and low-income children who rely on the

Medicaid and the Media: Sharing Stories for Good

The past few months have been rife with intense debate over our nation’s budget and the debt ceiling. Predictably, entitlement programs, especially Medicaid, have been on the chopping block in these conversations. While legislators were proposing plans th

OIG report shows only 5 States protected from drug pricing fraud

An OIG report issued Monday found that only a few state Medicaid programs have made plans to replace a widely-used but fraud-ridden pricing system for pharmacy reimbursement that will be discontinued this coming September in response to a consumer lawsui

Paving the Way for New Models of Care

Providing insurance to low-income populations, as Medicaid does, improves their overall health and helps maintain financial stability. A new study by the National Bureau of Economic Research, says that Medicaid recipients, on average, were more likely to

Setting the Record Straight on Medicaid

Earlier today, Community Catalyst joined 118 groups representing consumers, people of faith, and health care providers in 34 states to raise our collective voices in support of Medicaid. Together, we sent a response to the letter that Senator Hatch and Co

Guess what? Medicaid Matters

A new study today, the most robust of its kind in 40 years, concludes that Medicaid makes a big difference for its enrollees. The study, authored by the National Bureau of Economic Research, documented that Medicaid recipients, on average, were more like

States of Innovation 1

Saving Money, Saving Lives: Maryland Paves the Way on Payment Reform As policymakers across the country look to balance their budgets, some are turning to Medicaid, recycling the same harmful policies they’ve used year-after-year: eliminating coverage fo

Solving the Specialty Care Issues for Medicaid and CHIP Children

The New York Times ran an article last week on the results of a new study published in The New England Journal of Medicine (NEJM) on access to outpatient specialty care for children on Medicaid and the Children’s Health Insurance Program (CHIP). The study

When “State Flexibility” Means “Cutting Vulnerable Americans off Health Insurance”

On Tuesday, Senator Orrin Hatch and Congressman Phil Gingrey unveiled new legislation, The State Flexibility Act, which they touted as providing states with “greater Medicaid flexibility in order to innovate and better target health care spending.” Let’s

A Tale of Two Deficit Reduction Approaches

In his speech on Wednesday, President Obama laid out his plan for deficit reduction, and last week, Congressional Republicans released their 2012 budget proposal. Both plans reduce federal expenditures on Medicare and Medicaid, but they take strikingly di

Obama's Speech Today: A Listeners Guide for Health Care Advocates

Later today when the President speaks about the national debt, what should health care advocates be expecting and hoping to hear? Given that long-term projections of rising public debt rest almost entirely on growth in health spending, we should expect at

Less pain, more gain: defining an alternative to harmful Medicaid cuts

(please note most links below are pdfs) On Friday, Community Catalyst sent a letter to Secretary Sebelius, outlining eight policies states could implement to cut Medicaid costs. We were inspired to weigh in by a series of letters between the Secretary and
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